Department of Neurology, Yiwu Central Hospital, Yiwu, Zhejiang Province, China.
Neurol India. 2012 Jan-Feb;60(1):55-60. doi: 10.4103/0028-3886.93592.
Endovascular therapy of complicated ruptured anterior communicating artery (ACoA) aneurysms is difficult due to their small size and unfavorable shape.
Based on the anatomical features of the ACoA complex, we investigated the feasibility and efficacy of different coil embolism strategies for complicated ACoA aneurysms.
Sixteen patients with complicated ruptured ACoA aneurysms received endovascular treatment. Aneurysm sac plus ACoA embolism or ACoA coil embolism were performed if the bilateral A1 segment was normally developed or unilateral A1 segment dysplasia (≥1/2 normal contralateral diameter) was present. Where unilateral A1 segment dysplasia (<1/2 normal contralateral diameter) or aplasia was present, sac embolism alone was performed. Follow-up angiography was performed, and clinical follow-up data were categorized as fully recovered, improved, unchanged or worsened.
Aneurysm sac plus ACoA (n=5) or ACoA alone (n=2) coil embolism was performed in seven patients with normal bilateral A1 segments (n=5) or dysplasia (n=2). Sac coil embolism was performed in nine patients with unilateral A1 segment dysplasia (n=1) or aplasia (n=8). Immediate angiography indicated total/near-total occlusion was achieved in 14 patients. Final angiographic (mean 11.9 ± 5.1 months) and clinical (mean 17.7 ± 5.9 months) follow-up confirmed total/near-total occlusion in 12 patients, one partial occlusion, two enlarged residual sacs and one reopened aneurysm. Clinical symptoms fully recovered in 10 patients, improved in four, were unchanged in one and worsened in one patient.
This small middle-term follow-up study demonstrates coil embolism endovascular treatment of complicated ruptured ACoA aneurysms, based on the anatomical features of the ACoA complex, is feasible and effective.
由于前交通动脉瘤（ACoA）破裂后瘤体较小且形态不佳，腔内治疗较为困难。
基于 ACoA 复合体的解剖学特征，我们探讨了不同的线圈栓塞策略对复杂 ACoA 动脉瘤的可行性和疗效。
16 例复杂破裂的 ACoA 动脉瘤患者接受了血管内治疗。如果双侧 A1 段发育正常或单侧 A1 段发育不良（≥正常对侧直径的 1/2），则进行动脉瘤囊加 ACoA 栓塞或 ACoA 线圈栓塞；如果单侧 A1 段发育不良（<正常对侧直径的 1/2）或发育不全，则仅进行囊内栓塞。进行随访血管造影，并根据完全恢复、改善、不变或恶化对临床随访数据进行分类。
7 例双侧 A1 段正常（n=5）或发育不良（n=2）患者进行了动脉瘤囊加 ACoA（n=5）或 ACoA 单独（n=2）线圈栓塞，9 例单侧 A1 段发育不良（n=1）或发育不全（n=8）患者进行了囊内线圈栓塞。即刻血管造影显示 14 例患者达到完全/近完全闭塞。最终血管造影（平均 11.9±5.1 个月）和临床（平均 17.7±5.9 个月）随访证实 12 例患者达到完全/近完全闭塞，1 例部分闭塞，2 例残余囊扩大，1 例动脉瘤再通。10 例患者临床症状完全恢复，4 例改善，1 例无变化，1 例恶化。
这项小的中期随访研究表明，基于 ACoA 复合体的解剖学特征，线圈栓塞血管内治疗复杂破裂的 ACoA 动脉瘤是可行且有效的。
